This Interim Report does not provide final recommendations of the actions needed to improve the performance of the system or the equity of outcomes from the system.
The purpose of the Interim Report is twofold. To reflect back to the community and the sector what the Panel read, heard, and observed about the main issues affecting sector performance and the things that are working well that we can learn from. Second to indicate the directions of change the Panel believes are necessary.
This report should contain few surprises. We observed a high degree of consensus on the issues preventing the system being as effective as it could be.
There is much less consensus on the best way forward.
The reality is that the world is rapidly changing. Changing demographics alone will increase demands on the system making it unsustainable unless it operates very differently in the future.
Consumer expectations are changing. New technologies, climate change, increasing comorbidities, and growth in antimicrobial resistance etc are happening whether the system changes or not. But their impact on system performance for the least well off will be hugely different, depending on what actions are taken now.
Phase Two of the review will, therefore, focus on developing recommendations for the key changes that can best move the system towards more sustainable and fairer performance. We have indicated throughout this report the direction the Panel believes those changes should take, and these are set out below.
Developing our final recommendations will require us to answer specific questions in each of our focus areas. These questions include, but are in no way limited to, those set out in the next sections.
The Panel is clear that a more integrated health and disability system is needed that operates within an agreed set of values and principles, with clear decision frameworks, national long-term planning, and explicit accountabilities. The Panel is also clear that the mana of Māori as Tiriti / Treaty partner with the Crown must be reflected in the way the system is governed and in how and what services are provided.
Issues which need further analysis and discussion however include:
For many years, various health strategies have promised more emphasis on population health and early intervention to shift the focus from treatment to health and wellbeing. However, despite many good examples of local initiatives changing how services are designed and provided for small groups, there is no evidence of a large scale or sustained movement away from a treatment focus towards a prevention focus. Nor is there evidence of the wellbeing of individuals and communities being recognised as the main factor that should be driving the design of service provision.
The Panel is clear that progress for those individuals and communities who are currently missing out in the system, hinges crucially on two things happening. First, services need to be funded and provided in a way that enables them to be designed around the wellbeing of the individual and their whānau, rather than primarily the interests of providers. Second, services need to be available to all on a fair basis, so that where you live, your degree of disability, or your ethnicity is not a determining factor in the quality of care you receive.
Issues which need further analysis and discussion in these areas include:
The health and disability system workforce is the foundation on which the system is built. But the workforce is under considerable stress because of a shortage of supply and the prospect of ever-increasing demand for health and disability services. While technology offers an opportunity for positive change in the way services are provided, it will never remove the need for good interaction between health workers, consumers and their families and whānau.
For the workforce to be effective in the future, various enablers need to be strengthened. Principal among these is for the system to produce and use much better data. The future of the system, as with all other sectors, is largely digital, but the ability to apply that technology effectively depends on data systems being up to scratch. Our report suggests this is not the case at the moment, so priority needs to be given to improving data collection, analysis, and stewardship and to making technology systems properly interoperable.
The health and disability system is always going to need a significant amount of capital investment to provide the population with access to modern, safe, and appropriate facilities. The recent history of capital and infrastructure management in the system is not impressive, and there is little confidence in the transparency or credibility of the decision-making mechanisms. The Panel is clear a national asset management plan and a long-term investment strategy are needed as part of the long term service plan.
Many issues need further analysis and discussion. These include:
The questions above are illustrative, not exhaustive, and the questions cannot be answered by the Panel alone. The process from here will involve the Panel calling on people in the sector to work with it on various working groups to come up with more detailed options.
Many groups have already submitted quite detailed proposals, particularly relating to possible configuration of Tier 1 services, and the Panel intends to use these as a base to develop further.
As options are developed, further opportunities will be provided for interested parties to comment before the next report is finalised in March 2020.